Project Summary This National Research Service Award (F32) is designed to promote the development of Stephanie Goldstein as an independent, clinical research scientist focused on developing and evaluating strategies for measuring and intervening on health behaviors that capitalize on digital health technology. Behavioral obesity treatment (BOT) produces clinically significant weight loss and health benefits for many individuals with overweight/obesity and cardiovascular disease (CVD). Yet, about half of patients fall short of expected outcomes and most experience gradual weight regain, thus negating the benefits over time. Lapses (i.e., self- reported eating instances that deviate from the BOT prescribed diet) could explain poor outcomes, but the behavior is understudied because it is difficult to assess in-lab and via self-report. We therefore propose to study lapses using a multimethod approach with the following tools: ecological momentary assessment (EMA; repeated sampling method via mobile device), a wrist-worn device that automatically detects eating behavior and various eating characteristics (frequency, rate, and duration of eating episodes), and 24-hour dietary recalls. We will recruit participants (n=40) with overweight/obesity and one additional CVD risk factor to enroll in a 12-week BOT program and follow them through an additional 12-week period of weight loss maintenance. Participants will complete a biweekly 7-day EMA protocol to self-report on eating behavior, including the occurrence of dietary lapse. Participants will continuously wear the wrist-worn ActiGraph Link to characterize eating behavior. Lastly, participants will complete 24-hour dietary recalls via structured interview (split between days with and without lapses) at 6-week intervals to measure the composition of all food and beverages consumed. The proposed study approach is consistent with priorities of NHLBI to optimize clinical research and diagnostic strategies to improve CVD and related risk factors. This project will be conducted in combination with an individualized training program including a curriculum designed to facilitate the acquisition of key skills and experience to move the applicant towards her career goals. This includes didactic and experiential training related to the use of passive sensing technology and related analytic strategies in research, factors that can impede weight maintenance and dietary adherence in BOT, and administration and interpretation of validated nutritional assessment. The applicant will work closely with her primary sponsor, Dr. J. Graham Thomas, her co-sponsors Dr. Rena Wing (renowned expert in weight maintenance), Dr. Adam Hoover (electrical and computer scientist), and Dr. Whitney Evans (nutritional epidemiologist and registered dietician). This mentorship team, in combination with the infrastructure and resources available through the Miriam Hospital Weight Control and Diabetes Research Center and Alpert Brown Medical School, represent the ideal environment to accomplish the applicant's training goals, foster professional development and increase the applicant's autonomy as an independent clinical obesity researcher.